This Program Project proposal provides a comprehensive analysis of the psychological, social, economic, and medical outcomes of infertility diagnosis and treatment. The central theme is that couples and providers both face difficult decisions about the provision and use of reproductive technologies. Making the best choices requires comprehensive information about the likely costs and benefits, which may change during the course of treatment. Such information will permit better decision- making and outcomes for both patients and providers, and will identify the needs and opportunities for intervention during the trajectory of the diagnosis and treatment of infertility. The overall goals of the Program Project are to: (1) provide information on the costs and benefits of reproductive technology that will allow for better decision making and outcomes for both patients and providers; (2) identify the needs and opportunities for intervention during the trajectory of diagnosis and treatment of infertility, and (3) translate the findings into information that is useful for those considering the use of ARTs, clinicians, and policy markers. The aim of the project is to provide information that will be of use to infertile couples, providers of fertility services, insurers, health care purchasers and health care policy makers. The Program Project Director will be Nancy Adler, Ph.D., who will head the Steering Committee (SC). The SC will supervise and coordinate the activities of the Administrative Core; the Core for Data Collection, Management, and Analysis; the Advisory Board; and the component research projects. The component research projects will study decision- making processes of couples who are going through infertility treatment, the impact of these choices on couples' marital satisfaction and psychological well-being, the economic and social costs of these choices, and the pregnancy and birth outcomes that result from infertility and technological intervention. Data for three projects will be obtained by following a cohort of couples who seek an initial consultation of ART. A four project uses a different (and larger) database to determine the potential increased risk of adverse obstetric and pediatric outcomes in pregnancies resulting from treatment. The advantages of conducting together as a Program Project include the comprehensive analysis and multi-disciplinary perspective provided by the investigators, significant economies of scale as a result of using a single patient population for some and common methodologic and clinical support for all projects, and use of a common administrative structure. Most importantly, all projects draw upon existing relationships with infertility service providers in Northern California, without which a project as this could not be undertaken.